Top 10 Infection Control Challenges

The spotlight is shining on infection control chiefs. The burden is on them to identify weaknesses and danger zones within their hospitals, not only to improve patient safety, but to thwart any financial penalties Medicare might impose on their organizations in the months and years ahead.

It's a big responsibility, especially with continued pressure from federal reports that remind inpatients that one in 20 of them will contract a hospital-acquired infection, with annual direct medical costs to U.S. hospitals ranging from $28.4 billion to $45.7 billion a year in 2007 dollars.

What's uppermost on their minds? What do they think are the most pressing problems, issues and concerns they hope to address? Infection control experts shared their toughest challenges:

1. Clostridium difficile"C. diff and diarrhea have become a huge problem at our hospitals," Stephen Parodi, Chief of Infectious Disease for 21 hospitals in Kaiser Permanente's Northern California system said in a telephone interview. Parodi said that C. diff is more common than the combined rate of central line bloodstream infections, catheter associated bloodstream infections and ventilator associated pneumonia.

An important undertaking within Kaiser hospitals and many other facilities across the country is how to empower nurses to recognize patients with diarrhea as potentially harboring C. diff, isolating them and testing them immediately to minimize the chance of the spread of the bacteria, he said.

""The attributable mortality one-year out from having the original infection is 16.7% – and that's pretty high. It's almost one-sixth of the people are not alive in a year. And remember, it's not the thing the patient originally came in with."

2. Handwashing
Estimates vary among hospitals and various units, from as low as 30% compliance to well above 80%. But experts agree that improving and then sustaining good hand-washing practices is an ever-present challenge.

To make it easier, patient units can be revamped at minimal expense so that dispensers are placed as conveniently as possible to patient care practices, and become an automatic step for the care provider entering and leaving the room.

But next up is to create a system to monitor healthcare workers' handwashing practices without creating a system in which workers instinctively wash their hands only when the monitors – whose identities will quickly become known – are present.

And some workers will object to a big-brother intrusion on their practices. "But we really at a point where we need to draw a line in the sand," Parodi said. "This is just something that has to be done. We don't tolerate unsterile conditions in the operating room, and that's audited...I don't see this as any different just because a patient on a regular hospital floor, why shouldn't we expect the same standards?"

Parodi and others discussed technology that uses electronic means to conduct hand hygiene surveillance, perhaps with a radiofrequency tag. "We need to look into these technologies to figure out if we have an objective quality measure," he said. Some of these products have yet to be thoroughly tested.

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